Health Care and the Terrible, Horrible, No Good, Very Bad Day

Health Care and the Terrible, Horrible, No Good, Very Bad DayWell, they did it. They came up with the worst possible “replacement” for the Affordable Care Act.

The horrific plan that the House Republicans passed on Thursday threatens not only the health insurance of 24 million people, but those of us lucky enough to have employer-provided health insurance, anyone covered under Medicaid, and anyone who ever dreamed of leaving the security of an employer to start their own business or otherwise follow their dream.

Not only did they throw the baby out with the bathwater, but they buried her 10 feet deep in a remote spot in the Amazon.

In passing this appalling bill, the House Republicans: Confirmed, in no uncertain terms, that access to affordable, quality health care is a privilege, not a right. And it appears that the privilege is primarily available to rich white men. Clarified that they could care less about the people who put them in office, given the fact that fewer than 20% of Americans supported the earlier, less onerous version of the American Health Care Act (AHCA). … Continue Reading

ACA Affordable Care Act health insurance healthcare costs healthcare reform healthcare system; Medicare Obamacare

Why Does an MRI Cost $2,500 Here and $250 in Finland?

Why Does an MRI Cost $2,500 Here and $250 in Finland?Just had dinner last night with an old friend from Finland. He’s a physician so, of course, the talk turned to health care and the differences between our countries. I asked him how much an MRI cost in Finland. With a few clicks on his phone he had the answer: about $250. Not to be outdone, I pulled out my own phone. The average price of an MRI here? About $2,500.

And therein lies the problem. The US spends more per capita on health care than any other industrialized country in the world. And before you say we have the best healthcare system in the world, let me tell you that we don’t.

Our country ranks last or near the bottom on nearly every health-related outcome. Our life expectancy has actually dropped in the past couple of years for the first time in decades, with death rates rising for eight of the top 10 leading causes of death. We also have the highest rate of infant mortality, worse than Cuba, Poland, and Slovakia.

It’s like paying for a new Mercedes and … Continue Reading

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Replacing the ACA: Will Health Savings Accounts Work?

Replacing the ACA: Will Health Savings Accounts Work?

The problems with high-deductible plans and health savings accounts

Note: I am beginning a series of posts examining various approaches the Republicans are touting as replacements for the ACA. Sorry, but no alternative facts here.

Several years ago (ie, pre-ACA), I needed to buy health insurance on the open market. The cost of an individual policy and the deductible was atmospheric because I had a pre-existing condition. And, of course, the policy didn’t cover costs related to my pre-existing condition.

Luckily, I had just incorporated my business. Since I had two employees (my husband and I) I could get a small business policy. Still expensive but manageable with decent coverage since employer-provided plans can’t discriminate based on pre-existing conditions.

I chose the cheapest plan, which came with a very high deductible. This plan also allowed me to create a health savings account (HSA). Money deposited into an HSA is not subject to federal taxes, grows tax-free, and is not taxed when used for qualified medical expenses (but not premiums).

What a Health Savings Account Can’t Do … Continue Reading

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Winners and Losers: Assessing the Ramifications of Repealing Obamacare

Winners and Losers: Assessing the Ramifications of Repealing ObamacareAfter voting at least 60 times over the past six years to repeal the Affordable Care Act (ie, Obamacare) only to see their efforts stymied in the Senate, the Republican House is fairly foaming at the mouth at their golden opportunity to reach Nirvana now that they also control the Senate.

Indeed, the Senate passed a budget resolution on January 4 to begin the process, instructing the House to have a repeal bill ready by January 27. You can read how this might work in this excellent article in The New York Times.

There’s just one problem: Despite the six years they’ve spent trying to kill the ACA, the Republicans still have no replacement.

So here’s just a sneak peek at what might happen if they follow through on their threats.

10 Things We Will Lose if We Lose the Affordable Care Act Insurance for more than 20 million Americans. Guaranteed coverage without higher premiums for those with pre-existing conditions. This would affect the 52 million Americans, about a third of all adults, with pre-existing conditions. (There is talk of keeping … Continue Reading

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Memo to Health Insurers: Pay Attention to Us

Memo to Health Insurers: Pay Attention to UThe text came from our 20 year old. His girlfriend had gone to her doctor to get the implantable birth control, Nexplanon, which (as every parent of a teenager might be happy to know) is nearly foolproof for 3 years. Needless to say, we were thrilled.

The problem?

It cost $1,500 and insurance wasn’t paying.

The Explanation of Benefits that Was Anything But

Impossible, I said (after all, there’s not much I know about but health insurance and the Affordable Care Act [ACA] are two). The ACA requires that most health insurers/employers provide all FDA-approved contraception with no out-of-pocket cost.

It took several back and forths between the girlfriend, her father, and me, including copies of the statement from the insurance company, before I figured it out. She was only seeing the insurance company statement, called an explanation of benefits (EOB), showing what was billed and what was paid. She didn’t owe a thing.

And therein likes one of the many problems with health insurance today. It’s unnecessarily complicated and confusing. After all, how many mere mortals … Continue Reading

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Value-Based Reimbursement: There’s a New Player in Town

Value Based Reimbursement Webinar


There’s a new player in town. In case you haven’t heard, his name is VBR – value-based reimbursement. He’s smart. He’s tough. He’s out to break you down and build you up. And if you’re a healthcare provider, there is nowhere to hide.

For several years now I’ve been writing about the “coming” revolution in healthcare reimbursement as the system moves from a fee-for-service approach (ie, the more you do, the more you earn) to one based on cost and outcomes, aka, value. Well, the revolution has begun. Just consider:

➢ On April 1, nearly 70 hospital systems will switch from billing separately for each component of a knee or hip replacement to receiving a bundled payment for all care provided from the time the patient enters the hospital until 90 days after discharge. Just consider the possibilities!

➢ Two weeks ago, the Centers for Medicare & Medicaid Services (CMS), which is driving the value-based revolution, announced a proposal to change the way physicians are paid for drugs administered in their offices (mainly oncology medications).

Today, doctors get the … Continue Reading

Affordable Care Act healthcare costs healthcare reform healthcare system; Value-based reimbursement

How Much Is That CT Scan In the Window?

transparencyDo you know how much that 50-inch, flat-screen TV cost? How about your car? The cashmere cardigan you just had to have?

So how much did that visit with your gyn because of your painful period cost (men: substitute whatever you want here)? The ultrasound to see if you had a fibroid? The myomectomy to remove the fibroid?

A few years ago it didn’t matter so much; most of us only had to handle relatively small copayments and many of us didn’t even have deductibles. Fast forward to today, when the cost job-based health insurance has grown faster than our incomes, essentially eating up any salary increases over the past 10 years. In fact, the average deductible has more than doubled for most employees regardless of the size of their companies.

Note I said the past 10 years. Which means you can’t blame the five-year-old Affordable Care Act entirely. In fact, out-of-pocket payments would likely be higher without the ACA; a recent report from the Commonwealth Fund found a “marked slowdown in premium growth in 31 states and the District of Columbia.” However, that same report also found that premiums increased about … Continue Reading

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A Letter to a Friend (or, I’m Sorry I Lost My Temper Last Night”)

Sibling RivalrySo I did something last night that I’m not proud of. I got into an argument – complete with raised voices – with a friend. Over health care and the Affordable Care Act (ACA), of course. (Note that he continually called it “Obamacare” in a somewhat sneering tone, which, as those of you who read my blog regularly or know me, know I consider a derogatory term for a very important piece of legislation).

I felt terrible after we left and tossed and turned all night coming up with things I wished I said (not to mention wishing I hadn’t lost my temper).

So I decided to write my friend a letter via this blog.

Dear Friend:

I am really sorry about last night’s discussion, er, argument. I should have remained calmer (I’m blaming it on the martini you made me, which, by the way, was very, very good). So here is a cooler version of responses to some of the points you made.

The government should not be paying for health insurance.

Well, I notice that you are quite … Continue Reading

Affordable Care Act blog health insurance healthcare costs healthcare reform healthcare system; Obamacare

Why Repealing the Affordable Care Act Won’t Stop Healthcare Reform

So the election is over. The Republicans now control both houses. And several are promising that one of their first jobs is to repeal the Affordable Care Act (ACA). I’m sure there are lots of people jumping up and down with glee.

This reaction reminds me what one doctor told me a couple of weeks ago after I spoke to his group (abdominal surgeons) about healthcare reform (you can read more about the experience here). “This (the ACA) is going to go away and things will return to normal.”

Um, not quite.

Sure, if the ACA goes away we’ll return to more than 40 million uninsured Americans who can’t afford health care. States that have expanded Medicaid will have to pick up the full tab for those expansions (instead of 10% beginning in 2020). Young adults who are still covered on their parents’ policies will now have to buy their own — if they can afford them. Women will once again be discriminated against in terms of premiums and plan designs. People with preexisting conditions will be unable to find affordable health insurance on the individual market. We’ll have no guarantee of a basic set of benefits (for instance, some … Continue Reading

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